As the final months of medical school approach, it surprises me how much my role has changed in the lives of my patients, my classmates and school mates, my family, and the physicians with whom I work. As a third year medical student, I at times lamented our sorry state of existence: we served as scut monkeys for the interns, lightning rods for upper-level residents and attendings who needed fodder for making an example or simply a transient and “safe” target for displacement, irritating space invaders and time wasters to the nurses, and inadequate messengers for demanding patients and their family members who wanted an occluded IV infusion alarm turned off, or a second breakfast, or quite legitimately, a realistic estimate as to when the doctor would come visit. More often than not, however, I remember having a more positive influence:
• as an assist to the interns and residents who could be trusted with obtaining key information, examining and interviewing patients accurately, discussing issues with consult physicians, and even writing orders (or the equivalent in the Operating Room: cutting and suturing).
• as an ally to the nurses who could rely on us to help with everyday tasks and ensure that important observations were brought to the attention of the residents and attendings (usually translating into new written orders or order modifications).
• as a proxy for the physicians when they otherwise didn’t have the time or opportunity to counsel and educate patients (including one time when a rather belligerent patient “fired” the rest of the medical team). My fiancée, currently on her Medicine subinternship (a fourth year clinical rotation where the medical student has similar responsibilities to a first year resident), recently counseled a patient who had many questions about her complicated medical condition and the tough decisions being made, and when the resident came in to see and counsel the patient, the patient told him, “That’s ok, she (my fiancée, the medical student) already explained everything to me and answered my questions.”
• as the consistent “doctor” to patients who otherwise are visited by a dozen different residents, specialists, nurses, and therapists each day (who have many more patients to see than me). Some of my attendings said, “I’ll know you’re a good medical student if I ask the patient ‘Who’s your doctor?’ and he points to you.”
• as an enthusiastic student to the attendings who sometimes depends on us to ask good questions, stimulate discussion, or simply remind the medical team that we are working in an educational institution and that we have a mission to preserve and expand the fund of medical knowledge and use this knowledge to the benefit of mankind.
• as an equal practitioner of certain aspects of the “art” of medicine: empathizing with the patient’s suffering and anxiety, equilibrating to the moods and attitudes of the patient and her family, knowing when to smile or frown or laugh, using physical contact in the right ways and at the right times to strengthen the doctor-patient connection, maintaining an appropriate demeanor and veneer, expertly managing the giving and receiving of knowledge with the right tempo and cadence, knowing and expressing what you can and cannot do for the patient, and showing constancy in providing hope and guidance through the most difficult of times.
All of these are potential roles for the third year medical student. I have happily assumed all of the more positive roles, and I reluctantly find minimal value in the more negative positions if only to be able to show the red badge of courage to the naturally cynical and more senior generation of physicians who believe that today’s young doctors are too soft and pampered. My disclaimer and proclamation: I survived the Charity Hospital system.
Now, as a fourth year medical student, I have shed some of the less desirable roles and gained a few others: marginally more experienced teacher to third year medical students, cautious and suddenly more aware health advisor to family members, potential future colleague to residents, and potential trainee and employee to attendings and residency programs. From this vantage point, I’m starting to glimpse the coming transition to physician status, one which is commonly reported by first year residents to be hardly a noticeable transition in personal qualities at all – only a transition in personal responsibilities. Accordingly, I plan to use these final seven months to brace for the next new role: doctor (without quotations).